Dementia is a universal disorder a...

Dementia is a universal disorder among older persons, and projections indicate that the number of patients with dementia in the United States will continue to bourgeon Alzheimer's disease and vascular dementia account for the majority of cases of dementia. After a thorough history and physical examination, including a discussion with other family members, a baseline measurement of cognitive function should be obtained. The Mini-Mental State Examination is the principally commonly used instrument to document cognitive impairment. Initial laboratory evaluation includes criterions for thyroid-stimulating hormone and vitamin [Bsub12] evens Structural neuroimaging with noncontrast comput tomography or magnetic resonance imaging also is approveed Other testing should be guided through the history and physical examination. Neuropsychologic testing can help determine the amplitude of cognitive impairment, but it is not make acceptableed on a routine basis. Neuropsychologic testing may be greatest in number helpful in situations where screening experiments are normal or equivocal, moreover there remains a high horizontal of concern that the human frame may be cognitively impaired.

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Dementia someones and is a syndrome of gradual attack and continuing decline of higher cognitive functioning. It is a universal disorder in older becomes more prevalent in each decade of life. Approximately 10 percent of adults 65 years and older and 50 percent of adults older than 90 years, have dementia. It is general for older patients to near to family physicians with businesss of memory loss. With an accurate and timely diagnosis of dementia, appropriate therapies can be initiated to contract further cognitive decline. Therefore, family physicians play a solution role in evaluating patients with suspected dementia. Given conflicting recommendations about the initial evaluation of patients with dementia, the availability of genetic markers for Alzheimer's disease, and fresh neuroimaging methods such as positron emission tomography, confusion may arise concerning for what cause best to evaluate these patients. (1-6) This article reviews the evidence regarding the initial evaluation of the patient who not past nor futures with memory loss.

Signs and Symptoms of Dementia

Patients ofttimes present with concerns of modern memory loss. However, it is not infrequent for a family member to bring these regards to the physician because any patients deny their impairment or excuse the memory los as a normal part of aging. The diagnosis of dementia can be indicateed when there is an impairment in memory and an impairment of at least single in kind other area of higher cognitive functioning (eg taste abstract thinking, complex task performance, agnosia, apraxia, visuospatial awareness, personality change in the adjoining matter of deficits) that interferes with normal social and executive functioning in an otherwise alert individual (7)

Early symptoms that may prompt a dementing illness include difficulty in learning and retaining modern information, handling complex tasks, reasoning (for otherwise simple problem-solving), and enigmas with spatial awareness (finding one's way around familiar places), language (specifically difficulty expressing oneself or getting "lost" in conversations), and behavior (usually passive, suspicious, or more irritable or aggressive than usual). (6)

Differential Diagnosis

Alzheimer's disease accounts for 50 to 60 percent of all dementing illnesses. Vascular dementias (eg major cerebrovascular insults, microvascular pathology) are com-mon in 15 to 20 percent of patients, and oftentimes occur with Alzheimer's disease. The combination of Alzheimer's disease and vascular dementia or other dementing disorders is limited "mixed dementias." Conditions that may cause dementia are listed by dint of frequency in Table Less than 10 percent of dementias are caused on treatable conditions ("reversible dementia"). Because depression, vitamin [Bsub12] deficiency, and hypothyroidism ofttimes are comorbid conditions, it is not queer to treat an apparently reversible dementia solitary to find that symptoms were really caused according to Alzheimer's disease or vascular dementia.

Mental Status Examinations

Mental status examinations are used to mea-sure the rank of cognitive impairment. A number of instruments have been lay opened for this purpose. Five commonly used instruments and their characteristics are shown in Table 2 (9) These instruments measure performance in similar areas of cognitive function and take five to 10 minutes to administer and score. Each is reliable for ruling without dementia when results are negative.

MINI-MENTAL STATE EXAMINATION

The in the greatest degree frequently used mental state examination in North America is the Mini-Mental State Examination (MMSE) The MMSE measures many areas of cognitive functioning including memory, orientation to place and time, naming, reading, copying (visuospatial orientation), writing, and the ability to succeed a three-stage command. It can be administered in five to 10 minutes and is scored from naught to 30 points. A score of fewer than 24 points signifies cognitive impairment, although the example can be adjusted for educational flush (10) The MMSE is more specific unless less sensitive (i.e., gives more false negatives further fewer false positives) in highly educated individuals. It is avail-able online at http://www.minimental.com and http://www.aafp.org/afp/20010215/703.html.